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General NPI Number Information
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NPI Number | 1407479058
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Entity Type | Organization
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Legal Business Name | DOGWOOD DENTAL LLC
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Dates
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Enumeration Date | 05/18/2020
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Last Update Date | 05/18/2020
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Provider Practice Location Address
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Address Line | 262 N MAPLE ST
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City | ORLEANS
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State | IN
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Zip | 47452-1426
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Country | US
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Telephone | 812-279-9767
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Fax | 812-279-5971
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Provider Business Mailing Address
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Address Line | 1545 J ST
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City | BEDFORD
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State | IN
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Zip | 47421-3839
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Country | US
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Telephone | 812-279-9767
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Fax | 812-279-5971
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Authorized Official
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Title or Position | DENTIST
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Name | DR. NICKOLAUS M WEISS
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Credential | DDS
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Telephone | 812-279-9767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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